Elevate Your Emergency Nursing Practice

020 A Hydromorphone-Free ED? w/Sergey Motov, MD

Sergey M. Motov, MD, FAAEM

Courtesy of Sergey M. Motov, MD

Twitter @painfreeED

Dr. Motov is an Emergency Medicine Physician practicing in the Department of Emergency Medicine at Maimonides Medical Center, Brooklyn, New York. He graduated from Medical Academy of Latvia and completed his EM residency at Maimonides Medical Center. Dr. Motov is an Associate Research Director who is passionate about safe and effective pain management in the ED. He has numerous publications on the subject of opioid alternatives in pain management, and is actively involved in growing this body of work both nationally and globally

A Candid Conversation on having a Hydromorphone-Free ED with Sergey Motov, MD FAAEM

This episode was recorded earlier in the year at the same time as the Deep Dive Continuous Sub-Dissociative Dose Ketamine discussion.

Are people forgetting how powerful hydromorphone is?

Some people do forget, majority have not been educated.

Why are we now using so much hydromorphone?

This medication was basically thrown at us. “Use it. It’s a great and safe medication alternative to morphine.” Without actual explanations of equi-analgesic conversion, potency, or lipophilicity (lipid solubility) in comparison to morphine.

Morphine 8mg or Hydromorphone 1mg?

There’s something mental about giving a single digit dose of an opiod versus double digit.

Opioid-Induced Hyperalgesia

The longer a patient uses opioids to treat pain, the patient will most likely develop hyperalgesia and will ultimately require a higher dose to treat their pain which will eventually lead to tolerance and possibly addiction. Constantly requires a higher dose.

Would you say it is a lot, in the middle, or a little? Did the previous pain medication make any change in your pain (a little change or moderate change)?

Remind patient that they have a condition that causes pain (acute or chronic) and we may not be able to remove all of the pain but we can take the edge off so you are more comfortable.

Ask the patient, “Even though you still have pain, is it something you can handle or tolerate right now? Or do you need more pain medication at this time?”

Pain may be 8/10 but tolerable – no more medication required at this time. Remind patient that if the pain creeps back, that they can always ask for more later.

Pain not tolerable and need a little more. Administer pain medication as indicated.

Repeat above steps until pain is optimized.

Acute exacerbation of Chronic pain

Ask patient if they are willing to try multiple medication modality that has been shown to help other patients in their condition. Concern that patient’s pain will just keep coming back and want to help patient to manage pain at home.

Most are willing to try with a little convincing. Remind patient that they can try these medications together and “let’s see what happens.” They are still in the ED and can always receive more if it doesn’t work.

Pain Education Awareness

85% patients come into the ED annually with complaints of pain.

Re-educate ourselves and our patients in how to approach patients’ pain.